Children's risk taking behaviors: the role of child-based perceptions of vulnerability and temperament

OBJECTIVE: To examine the relationship between perceptions of vulnerability, temperament, and children's risk taking behavior in a simulated home environment. METHODS: Children and their primary caregivers were interviewed regarding temperament and perceptions of vulnerability to injury. In addition, children's interactions with simulated hazards were observed in an environment representing a typical home. RESULTS: Children whose caregivers reported higher levels of activity were significantly more likely to report lower perceptions of vulnerability to injury and show increased risky behavior. After controlling for gender differences, children's risky behaviors were predicted from child-based perceptions of vulnerability. CONCLUSION: Perceptions of vulnerability and active temperaments represent significant risk factors for potential injuries in the home. Modifying perceptions of vulnerability as well as identifying at-risk temperaments for injuries is important to consider when developing effective interventions.     

Safety Hazards in Households with Young Children

Interviewed 230 mothers of young children concerning in-homeobservations of safety hazards related to burns, poisoning,and falls, and self-reported measures of maternal supervision,locus of control, social support, and safety attitudes. Thesewere supplemented by measures of mothers' risk perceptions,stress and coping, their child's previous injury experience,and indicators of the family's socioeconomic status (SES) collectedby telephone survey. SES was an important predictor of observedhome hazards. Child-related variables, risk perceptions, anddomain-specific attitudes had little influence on home hazards.Maternal supervisory style, rated on dimensions of protectiveness,was an important correlate of all types of household hazards.Results suggest that residential injury prevention strategiesfor young children should stress active as well as passive countermeasures.     

Mothers' home-safety practices for preventing six types of childhood injuries: what do they do, and why?

OBJECTIVE: To identify determinants of mothers' home-safety practices for preventing six types of common injuries to children (burns, poisoning, drowning, cuts, strangulation/suffocation/choking, and falls). METHODS: Home interviews were conducted with mothers of children 19-24 and 25-30 months old about home-safety practices. For each of 30 safety precautions to prevent these six types of injuries, mothers indicated whether or not they engaged in the practice, and explained why. RESULTS: Regression analyses revealed both common and unique determinants of mothers' home-safety practices to prevent these six types of home injuries. For burns, cuts, and falls, beliefs that child characteristics and parent characteristics elevated the child's risk of injury were the key determinants of the mother's engaging in precautionary measures. For drowning, poisoning, and suffocation/strangulation/choking, health beliefs also contributed to predict mothers' practices, including beliefs about potential injury severity and extent of effort required to implement precautionary measures. CONCLUSIONS: The factors that motivated mothers to engage in precautionary measures at home varied depending on the type of injury. Intervention programs to enhance maternal home-safety practices will need to target different factors depending on the type of injury to be addressed.     

Understanding unintentional injury risk in young children II. The contribution of caregiver supervision, child attributes, and parent attributes

OBJECTIVE: To identify child and parent attributes that relate to caregiver supervision and examine how these factors influence child-injury risk. METHODS: Mothers completed diary records about supervision of their young child (2-5 years) when at home. Standardized questionnaires provided information about child attributes, maternal attributes, and children's history of injuries. RESULTS: Correlations revealed that child attributes and parent attributes related both to actual maternal supervision and child-injury scores. Regression analyses to predict injury scores revealed child-temperament factors alone predicted all levels of severity (minor, moderately severe, and medically attended), but parent supervision also contributed to predict medically attended injuries. CONCLUSIONS: Both child and parent factors influenced caregiver's supervision of young children at home and related to child-injury risk. For medically attended injuries, child attributes and parent supervision both predicted risk, whereas for less serious injuries, child factors alone determined risk.     

Understanding toddlers' in-home injuries: I. Context, correlates, and determinants

Multimethod strategies (i.e., questionnaires, parents' observations, injury-event recording diaries, telephone and home interviews) were used to study in-home injuries experienced by toddlers over a 3-month period. Cuts, scrapes, and puncture wounds were the most common injuries. The majority of injuries affected children's limbs, and injuries most often occurred in the morning. Boys were injured most often in rooms designated for play, and a majority of their injuries followed from misbehavior. Girls were most often injured in nonplay areas of the home, with the majority of injuries occurring during play activities. Boys experienced more frequent and severe injuries than girls, although girls reacted more than boys to their injuries. Child factors relevant to injury included: risk taking, sensation seeking, and ease of behavior management. Temperament factors did not relate to child injury. Parent factors relevant to child injury included parents' beliefs about control over their child's health, protectiveness, and beliefs about child supervision. Regression analyses revealed that both child (i.e., risk taking) and parent (i.e., protectiveness) factors were significant determinants of child injury.     

Childhood unintentional injuries: factors predicting injury risk among preschoolers

OBJECTIVE: To examine the relationships between maternal perceptions of risk, stress, social support, safety-proofing behaviors, supervision practices and unintentional injuries to children under 5 years old. METHODS: Household interviews were conducted with 159 mothers who had a preschool-age child. The secondary data were part of a population-based study that collected self-report data and home observational data. Diaries were used for collecting prospective injury data. RESULTS: White children whose mothers were unemployed and whose homes needed repair were reported to be at higher injury risk than other children. Predicting a higher injury risk were children's behavioral characteristics as well as their being older than 2.5 years. Maternal social support, stress, and coping variables were not related to injury risk. Maternal perceptions of risk variables interacted with maternal safety behavior variables when predicting injury risk. CONCLUSIONS: Childhood injuries are predicted by a set of interrelated sociodemographic, cognitive, behavioral, and child-related factors.     

Understanding toddlers' in-home injuries: II. Examining parental strategies, and their efficacy, for managing child injury risk

Multimethod strategies (i.e., questionnaires, injury-event recording diaries, and telephone and home interviews) were used to study in-home injuries experienced by toddlers over a 3-month period and to identify anticipatory prevention strategies implemented by parents, on a room-by-room basis, that effectively reduced child injury risk. Three types of prevention strategies were used by parents: environmental (e.g., hazard removal, safety devices to prevent access), parental (e.g., increased supervision, parent modification of their own behavior to decrease injury risk for their child), and child based (e.g., teaching rules or prohibitions to promote safety), with parents often using a combination of these. Use of these strategies, and their efficacy to reduce injury risk, varied on a room-by-room basis. Nonetheless, two general conclusions are supported: (1) An emphasis on child-based strategies never decreases, and often elevates, risk of injury to toddlers; and (2) parental and environmental strategies, either singularly or in combination, serve protective functions that significantly reduce children's risk of in-home injury. Although it is commonplace for parents of children between 2 and 3 years of age to transition from environmental and supervision strategies to the use of teaching and rule-based ones to manage injury risk, doing so too early clearly elevates children's risk of injury in the home.     

Effects of Televised Safety Models on Children's Risk Taking and Hazard Identification

Objective: To examine effects of televised safety models onchildren's willingness to take physical risks and their abilityto identify injury hazards in common situations. Methods: Sixty children, between the ages of five and eightyears, were exposed to one of three TV stimulus programs: (1)a safety educational videotape, in which actors engaged in dangerousbehavior, suffered injuries, and then enacted alternative safebehaviors; (2) an animated cartoon, which portrayed charactersengaged in safety behaviors incidental to the main story line;or (3) the same cartoon program edited to omit the scenes depictingsafety behavior. Children's willingness to take physical riskswas measured before and after the TV stimulus by a series ofpictorial child-relevant scenarios in which they could indicatethe level of risk they would take. They also completed pretestand posttest measures of hazard identification, in which theywere to identify injury hazards in several pictorial scenarios. Results: Exposure to the safety educational videotape decreasedchildren's willingness to take physical risks and increasedtheir identification of injury hazards. Exposure to the animatedcartoon with incidental safety components did not affect risktaking, but did increase ability to identify hazards. Conclusions: Findings are interpreted as evidence of observationallearning and priming of thematically related knowledge by thetelevision stimuli. Implications for safety educational curriculaare discussed.     

Mothers' Anticipation and Prevention of Unintentional Injury to Young Children in the Home

Investigated anticipation and prevention of children's unintentionalinjuries in the home. 150 mothers of 1-, 2-, and 3-year-oldchildren kept weekly diaries of anticipated injuries and unanticipatedinjuries/near injuries to their child. Mothers anticipated between57 and 67% of all injury events, a majority when the child wasin the same room as the injury-causing agent prior to interactingwith it. Few anticipated injuries led to injury. In these casesno significant differences were found depending on child's ageand sex. In contrast, mothers of younger children most frequentlyreported preventing injury by physically restricting or movingthe child away and by changing the environment, whereas mothersof older children more frequently engaged in teaching.     

Brief report: parent report about health care use: relationship to child's and parent's psychosocial problems.

OBJECTIVE: To investigate the potential utility of asking parents about health care utilization as a means of identifying individuals at risk for psychosocial problems. METHOD: Parents of 366 children ages 2 to 16 completed questionnaires about their own, their child's, and their family's psychosocial functioning and health care utilization. RESULTS: Children and parents with high health care utilization were more likely to have psychosocial problems than those with low health care utilization. Sensitivity and specificity of health care utilization as a marker for psychosocial problems ranged from 43.8% to 68.8%. CONCLUSIONS: Although high rates of child health care utilization are related to the presence of psychosocial problems, use of this measure alone could result in many false-positive and false-negative identifications. Rather, use of health care utilization data in conjunction with other screening measures may be useful for alerting physicians to the possibility of both child and parent psychosocial problems.     

Interactions between child behavior patterns and parenting: implications for children's unintentional injury risk

OBJECTIVES: Two factors were considered as predictors of children's risk for unintentional injury: (a) children's temperamentally difficult behavior patterns and (b) parenting. Along with hypotheses to replicate previous univariate effects, it was hypothesized that active, involved parents with sufficient time resources might reduce injury risk among temperamentally at-risk children. METHODS: Study 1 used a retrospective design with a diverse sample of over 10,000 5-year-olds. Study 2 replicated Study 1 using a prospective design and behavioral data from a sample of over 1,000 children followed from 6 to 36 months of age. RESULTS: In Study 1, male gender, child hyperactivity, and family poverty predicted injury in a univariate manner. In Study 2, male gender and lack of positive parenting predicted injury in a univariate manner. Interaction effects also emerged: in Study 1 the interaction between child hyperactivity and parental time resources protected children from injury, and in Study 2 the interaction between child's difficult temperament and positive parenting protected children from injury. CONCLUSIONS: Children at increased risk for injury, i.e., those with hyperactive and difficult behavior patterns, might be protected in the environment of positive parenting. Theoretically, results suggest that researchers should consider Temperament x Environment interactions along with univariate predictors of outcome behavior. From an applied perspective, results have implications for the design of injury prevention campaigns: Parents who spend positive time with temperamentally difficult children might protect them from injury.     

Don't run with scissors: young children's knowledge of home safety rules

OBJECTIVE: To examine 4- to 6-year-old children's knowledge of their parents' home safety rules and to identify predictors of children's home injuries. METHODS: Within the context of an interview, parents completed a home safety questionnaire in which they specified home safety rules, rated their child's compliance with each rule, explained not having rules, reported on maternal supervision, and reported on the frequency of their child's injuries. We evaluated children's knowledge of home safety rules by having them play a home safety game designed for this study. RESULTS: Children spontaneously recalled only about half of their parents' home safety rules. Prompting resulted in their recognition of about 40% more rules. However, children's knowledge scores did not predict the frequency of their injuries. The best predictors of children's injuries were children's compliance with home safety rules and extent of parental supervision. CONCLUSIONS: These findings suggest that interventions to promote young children's safety knowledge will not likely reduce childhood injuries unless children consistently comply with these rules or parents supervise children to ensure compliance.     

Video analysis of communication in paediatric consultations in primary care.

BACKGROUND: There is a paucity of research evidence concerning communication in paediatric consultations between GPs, adults, and child patients. AIM: This study was carried out to identify features of the interaction between a doctor, a child patient aged 6-12 years, and their carer in the consultation associated with the child's participation. DESIGN OF STUDY: A qualitative analysis of video recordings of 31 primary care paediatric consultations was undertaken, using strategies from the methodology of conversation analysis. SETTING: Primary care, Suffolk, UK. METHOD: NHS GPs from three primary care trusts (PCTs), were invited to participate in this study. Sixteen volunteers from this sample took part. RESULTS: Analysis of the interaction in the consultations revealed that the children had little involvement. Children participated when invited to do so, and took more time than adults to answer a doctor's question. An adult carer was less likely to answer on behalf of a child, when they were in a position to see that the doctor's gaze was directed at the child, and the doctor addressed the child by name. Adult carers, who had not voiced their own concerns first, were seen to interrupt doctor-child talk. In consultations where the participants sat in a triangular arrangement, all parties being an equal distance apart, triadic talk was noted. CONCLUSION: Child involvement in the primary care consultation is associated with adult carers being able to voice their own concerns early in the consultation, and children being invited to speak with the appropriate recipient design.     

Intergenerational transmission of somatization behaviour: a study of chronic somatizers and their children

BACKGROUND: Exposure to an ill parent in childhood may be a risk factor for adult somatization. This study examines the hypothesis that somatizing adults are more likely to have been exposed to illness as a child and that in turn, their children are more likely to report ill health and to have more contact with medical services than children of other mothers. METHOD: A cross-sectional comparative investigation of three groups of mothers and their children of 4-8 years of age: (i) 48 mothers suffering from chronic somatization; (ii) 51 mothers with chronic 'organic' illness; and (iii) 52 healthy mothers was carried out. RESULTS: Somatizing mothers were more likely than other women to report exposure to childhood neglect and to physical illness in a parent (OR 2.9; 95% CI 1.4-6.1). The children of these somatizing mothers were more likely to have health problems than were the children of organically ill or healthy women and had more consultations with family doctors (average annual rates: somatizers 4.9 (S.D. 3.8), organic 3.0 (S.D. 3.5) and healthy 2.8 (S.D. 2.6)). Multivariate modelling of consultation rates among children found significant main effects for maternal somatization, maternal childhood adversity, the child's tendency to worry about health and a two-way interaction of maternal childhood adversity and her somatization status. CONCLUSIONS: The hypotheses are broadly supported. However, it is important to emphasize the extent to which these findings are based on maternal reports.     

The role of parents and temperament on children's estimation of physical ability: links to unintentional injury prevention

OBJECTIVE: Unintentional injuries, the leading cause of pediatric mortality, are caused by a complex set of intrapersonal and environmental factors. The role of three critical variables--parental supervision, children's temperament, and estimation of children's physical abilities--was examined. METHODS: Sixty-four 6- and 8-year-old children completed a laboratory experiment with a parent. Both children and parents judged the child's ability to complete reaching, stepping, and crouching tasks. Parents also completed a parent-report measure of children's temperament. RESULTS: Both children and parents overestimated children's ability, although children did so more than parents. Parents of temperamentally impulsive and undercontrolled children judged that their children could complete tasks that were actually beyond the child's ability. Temperament also affected children's judgments while parents were known to be present or absent: Temperamentally impulsive and undercontrolled children were more accurate in their judgments when parents were standing next to them than when parents were hidden from view behind a one-way mirror. CONCLUSIONS: The mechanism by which parental supervision might protect children from injury appears to be at least twofold: (a) Parents overestimate children's ability less frequently than children themselves, suggesting supervising parents could intervene to prevent children from attempting dangerous activities; and (b) children judge their physical abilities more cautiously when parents are present. Implications for temperament theory and for injury prevention are discussed.     

Brief report: the impact of maternal posttraumatic stress disorder symptoms and child gender on risk for persistent posttraumatic stress disorder symptoms in child trauma victims

OBJECTIVE: To longitudinally examine the impact of maternal posttraumatic stress disorder symptoms (PTSS) on child adjustment following a child's traumatic injury, focusing on child gender differences. METHODS: Forty-one child traumatic injury victims aged 8-18 years and their biological mothers were interviewed over two follow-ups (6 weeks and 7 months). Children were administered the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale for Children and Adolescents (CAPS-CA), whereas mothers completed the CAPS. RESULTS: Six weeks post trauma, maternal PTSS were significantly related to PTSS in boys but not in girls. However, at 7 months, maternal PTSS were strongly related to child PTSS in both boys and girls. Significant 6-week maternal distress-child gender interactions suggested that maternal PTSS, especially avoidance, predicted greater 7-month PTSS but that this was primarily because of a significant relationship in females. CONCLUSIONS: Maternal distress was found to negatively impact subsequent child adjustment, particularly in females. These results underscore the importance of considering family-centered interventions for child PTSD, especially in girls.     

Predictors of unintentional injuries to school-age children seen in pediatric primary care.

OBJECTIVE: To identify predictors of unintentional injury to school-age children seen in pediatric primary care. METHODS: Members of a managed health care system (295 children ages 5-11 years and their mothers) participated. We used Time 1 measures of child, maternal, and family functioning and health care utilization to predict rates of unintentional child injury for the following year. Multiple regression analyses were performed to identify variables contributing to prospective injury rates. RESULTS: The final regression model included eight Time 1 variables and accounted for 21% of the variance in Time 2 injury rates. Significant predictors of increased injury liability were younger child age, more children at home, child behavior problems, child social competence, three indices of reduced child health, and maternal anxiety. CONCLUSIONS: We discuss the utility of these predictors for pediatric psychologists in targeting primary care preventive interventions to families at risk for unintentional child injury.     

Parental posttraumatic stress symptoms as a moderator of child's acute biological response and subsequent posttraumatic stress symptoms in pediatric injury patients

OBJECTIVE: To examine how parental responses following pediatric injury may influence their child's posttraumatic stress symptoms (PTSS). METHODS: Heart rate (HR) from 82 pediatric injury patients was measured during emergency medical services (EMSs) transport and following hospital admission. Twelve-hour urinary cortisol levels were assessed upon admission. Child PTSS and parental PTSS and general distress were assessed 6 weeks and 6 months after trauma. RESULTS: Six-week parental PTSS predicted 6-month child PTSS even after controlling for demographics and general parent distress (DeltaR(2) = .08, p = .03). Parental PTSS moderated the relationship between (a) child cortisol levels and 6-month child PTSS (DeltaR2 = .08, p = .03) and between (b) hospital HR and 6-month child PTSS (DeltaR2 = .09, p = .03). CONCLUSION: The present findings suggest that parental response to trauma may interact with child acute physiological responses to predict persistent child PTSS.     

Behavior of injured and uninjured children and their parents in a simulated hazardous setting.

Compared the behavior of parents and their previously injured children with parents and their uninjured children in unstructured play and distracted parent conditions. Injured children were more disruptive, more active, and had more contacts with hazards, whereas uninjured children had more appropriate behavior. Parents of injured children had lower rates of play activities. Observable classes of parent and child behaviors amenable to change were associated with a history of child injury. Further study is needed to assess the use of safe and unsafe behavior as proxy measures for injuries and to identify functional classes of safe and unsafe behavior for which active strategies can be developed to prevent children's injuries.     

Parent and child reporting of negative life events: discrepancy and agreement across pediatric samples

OBJECTIVE: To examine the consistency in child and parent reporting of child's negative life events across child/pediatric samples. METHODS: A total of 613 child-parent dyads provided independent reports of negative life events. The pairs included three groups consisting of children who were healthy (n = 362), diagnosed with cancer (n = 130), and diagnosed with a chronic illness (juvenile rheumatoid arthritis, diabetes, or cystic fibrosis; n = 121). RESULTS: Children reported significantly more negative life events than their parents reported for them. Additionally, children in the chronically ill group self-reported significantly fewer negative life events than the other groups. However, parents of children with cancer reported significantly more negative life events than the other groups. Although discrepancies exist in all three samples, parents and children in the healthy group were significantly more discrepant than the other groups. CONCLUSIONS: These results suggest that communication of children's life events between parent and child may increase during children's experience of cancer or a chronic illness. However, significant discrepancies remain in child and parent report of negative life events. Because of this, clinicians are encouraged to recognize the strengths and limitations of using multiple reporters in assessing negative life events in children.